Overview
Rheumatoid arthritis (RA) can affect the cervical spine, leading to inflammation and potential instability 2. This can manifest as pain, myelopathy, or radiculopathy 1.Diagnosis
Suspected atlanto-axial instability (non-traumatic) is a clinical scenario for which referral guidelines exist 1.
Imaging is used to assess for myelopathy and suspected spinal infection 1.Management
Acrylic reconstruction using a transcervical-transclival approach with methylmethacrylate is described for ascending luxation of the odontoid by rheumatoid arthritis 2.
This surgical approach provides access to the craniocervical junction 2.Key Recommendations
Referral guidelines exist for suspected atlanto-axial instability (non-traumatic) 1. (Evidence: Expert opinion)
Referral guidelines exist for myelopathy 1. (Evidence: Expert opinion)
Referral guidelines exist for suspected spinal infection 1. (Evidence: Expert opinion)References
1 Hamel C, Avard B, Dea N, Margau R, Mattar A, Michaud A et al.. Canadian Association of Radiologists Spine Imaging Referral Guideline. Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes 2025. link
2 Lesoin F, Pellerin P, Thomas CE, Lozes G, Carini S, Jomin M et al.. Acrylic reconstruction of an arthritic cervical spine using the transcervical-transclival approach. Surgical neurology 1984. link90134-4)